Bridge-to-Decision Therapy With a Continuous-Flow External Ventricular Assist Device in Refractory Cardiogenic Shock of Various Causes

Hiroo Takayama, Lori Soni, Bindu Kalesan, Lauren K. Truby, Takeyoshi Ota, Sophia Cedola, Zain Khalpey, Nir Uriel, Paolo Colombo, Donna M. Mancini, Ulrich P. Jorde, Yoshifumi Naka

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background-Mortality for refractory cardiogenic shock remains high. In this patient cohort, there have been mixed results in mechanical circulatory support device use as a bridge-to-decision therapy. We evaluated a continuous-flow external ventricular assist device (VAD), CentriMag VAD (Thoratec Corp., Pleasanton, CA), in patients with various causes of refractory cardiogenic shock. Methods and Results-This is a retrospective review of adult patients who underwent surgical CentriMag VAD insertion as bridge-to-decision therapy. From January 2007 through June 2012, 143 patients received CentriMag VAD. The cause of refractory cardiogenic shock was failure of medical management in 71 patients, postcardiotomy shock in 37, graft failure post-heart transplantation in 22, and right ventricular failure post-implantable left VAD in 13. Mean age was 52'16 years, and 71% were in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 1. Among 158 device runs, device configuration was BiVAD in 67%, isolated right VAD in 26%, and isolated left VAD in 8%. Median duration of support was 14 days (interquartile range, 8-26). Survival was 69% at 30 days and 49% at 1 year. The next destination after the CentriMag VAD was myocardial recovery in 30%, device exchange to an implantable VAD in 15%, and heart transplantation in 18%. The failure of medical management and the graft failure post-heart transplantation groups had higher 30-day survival compared with the postcardiotomy shock group. Major bleeding events occurred in 33% and cerebrovascular accidents in 14%. There was no CentriMag pump failure or thrombosis. Conclusions-Bridge-to-decision therapy with CentriMag VAD is feasible in a variety of refractory cardiogenic shock settings. Patients with postcardiotomy shock have inferior survival.

Original languageEnglish (US)
Pages (from-to)799-806
Number of pages8
JournalCirculation: Heart Failure
Volume7
Issue number5
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

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Heart-Assist Devices
Cardiogenic Shock
Heart Transplantation
Therapeutics
Shock
Equipment and Supplies
Survival
Transplants
Registries
Thrombosis
Stroke
Hemorrhage

Keywords

  • Heart-assist devices
  • Shock, cardiogenic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Bridge-to-Decision Therapy With a Continuous-Flow External Ventricular Assist Device in Refractory Cardiogenic Shock of Various Causes. / Takayama, Hiroo; Soni, Lori; Kalesan, Bindu; Truby, Lauren K.; Ota, Takeyoshi; Cedola, Sophia; Khalpey, Zain; Uriel, Nir; Colombo, Paolo; Mancini, Donna M.; Jorde, Ulrich P.; Naka, Yoshifumi.

In: Circulation: Heart Failure, Vol. 7, No. 5, 01.09.2014, p. 799-806.

Research output: Contribution to journalArticle

Takayama, H, Soni, L, Kalesan, B, Truby, LK, Ota, T, Cedola, S, Khalpey, Z, Uriel, N, Colombo, P, Mancini, DM, Jorde, UP & Naka, Y 2014, 'Bridge-to-Decision Therapy With a Continuous-Flow External Ventricular Assist Device in Refractory Cardiogenic Shock of Various Causes', Circulation: Heart Failure, vol. 7, no. 5, pp. 799-806. https://doi.org/10.1161/CIRCHEARTFAILURE.113.000271
Takayama, Hiroo ; Soni, Lori ; Kalesan, Bindu ; Truby, Lauren K. ; Ota, Takeyoshi ; Cedola, Sophia ; Khalpey, Zain ; Uriel, Nir ; Colombo, Paolo ; Mancini, Donna M. ; Jorde, Ulrich P. ; Naka, Yoshifumi. / Bridge-to-Decision Therapy With a Continuous-Flow External Ventricular Assist Device in Refractory Cardiogenic Shock of Various Causes. In: Circulation: Heart Failure. 2014 ; Vol. 7, No. 5. pp. 799-806.
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abstract = "Background-Mortality for refractory cardiogenic shock remains high. In this patient cohort, there have been mixed results in mechanical circulatory support device use as a bridge-to-decision therapy. We evaluated a continuous-flow external ventricular assist device (VAD), CentriMag VAD (Thoratec Corp., Pleasanton, CA), in patients with various causes of refractory cardiogenic shock. Methods and Results-This is a retrospective review of adult patients who underwent surgical CentriMag VAD insertion as bridge-to-decision therapy. From January 2007 through June 2012, 143 patients received CentriMag VAD. The cause of refractory cardiogenic shock was failure of medical management in 71 patients, postcardiotomy shock in 37, graft failure post-heart transplantation in 22, and right ventricular failure post-implantable left VAD in 13. Mean age was 52'16 years, and 71{\%} were in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 1. Among 158 device runs, device configuration was BiVAD in 67{\%}, isolated right VAD in 26{\%}, and isolated left VAD in 8{\%}. Median duration of support was 14 days (interquartile range, 8-26). Survival was 69{\%} at 30 days and 49{\%} at 1 year. The next destination after the CentriMag VAD was myocardial recovery in 30{\%}, device exchange to an implantable VAD in 15{\%}, and heart transplantation in 18{\%}. The failure of medical management and the graft failure post-heart transplantation groups had higher 30-day survival compared with the postcardiotomy shock group. Major bleeding events occurred in 33{\%} and cerebrovascular accidents in 14{\%}. There was no CentriMag pump failure or thrombosis. Conclusions-Bridge-to-decision therapy with CentriMag VAD is feasible in a variety of refractory cardiogenic shock settings. Patients with postcardiotomy shock have inferior survival.",
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AU - Soni, Lori

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AU - Truby, Lauren K.

AU - Ota, Takeyoshi

AU - Cedola, Sophia

AU - Khalpey, Zain

AU - Uriel, Nir

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AU - Mancini, Donna M.

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AB - Background-Mortality for refractory cardiogenic shock remains high. In this patient cohort, there have been mixed results in mechanical circulatory support device use as a bridge-to-decision therapy. We evaluated a continuous-flow external ventricular assist device (VAD), CentriMag VAD (Thoratec Corp., Pleasanton, CA), in patients with various causes of refractory cardiogenic shock. Methods and Results-This is a retrospective review of adult patients who underwent surgical CentriMag VAD insertion as bridge-to-decision therapy. From January 2007 through June 2012, 143 patients received CentriMag VAD. The cause of refractory cardiogenic shock was failure of medical management in 71 patients, postcardiotomy shock in 37, graft failure post-heart transplantation in 22, and right ventricular failure post-implantable left VAD in 13. Mean age was 52'16 years, and 71% were in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profile 1. Among 158 device runs, device configuration was BiVAD in 67%, isolated right VAD in 26%, and isolated left VAD in 8%. Median duration of support was 14 days (interquartile range, 8-26). Survival was 69% at 30 days and 49% at 1 year. The next destination after the CentriMag VAD was myocardial recovery in 30%, device exchange to an implantable VAD in 15%, and heart transplantation in 18%. The failure of medical management and the graft failure post-heart transplantation groups had higher 30-day survival compared with the postcardiotomy shock group. Major bleeding events occurred in 33% and cerebrovascular accidents in 14%. There was no CentriMag pump failure or thrombosis. Conclusions-Bridge-to-decision therapy with CentriMag VAD is feasible in a variety of refractory cardiogenic shock settings. Patients with postcardiotomy shock have inferior survival.

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